Supraventricular and ventricular arrhythmias: medical management

Cardiac arrhythmia results in significant morbidity and mortality in the developed world and presents an ever-increasing economic burden on health services. Optimal heart rhythm management improves patients' quality of life, and the timely diagnosis and treatment of patients with arrhythmias also facilitates the provision of cost-effective and potentially life-saving treatments. The diagnosis of patients presenting with arrhythmias requires ECG interpretation skills, which can readily be acquired by non-specialists, permitting safe and effective acute management. The additional understanding of arrhythmia pathogenesis and basic pharmacology is the 'icing on the cake' in terms of understanding emergency department management and the principles of long-term care of patients with arrhythmia. This article aims to provide the reader with a 'toolkit' for the medical management of cardiac arrhythmias, with a particular focus on acute settings. The indications for other important therapies, such as catheter ablation and implantable cardioverter-defibrillators, are outlined as appropriate, but these subjects are covered fully elsewhere.